Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada; Joint Centre for Bioethics, University of Toronto, 155 College St, 7th Floor, Toronto, ON, M5T 3M6, Canada.
Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada; Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.
Health Policy. 2024 Nov;149:105172. doi: 10.1016/j.healthpol.2024.105172. Epub 2024 Sep 24.
Medical Assistance in Dying (MAID) was decriminalized in Canada in 2016 for individuals 18 years or older who met eligibility criteria. Currently, individuals younger than 18 years are legally permitted to access an assisted death in the Netherlands and Belgium, but not in Canada. To-date, no work has compared factors shaping the policy processes and outcomes in these three countries. Therefore, our objective was to explore the legalities of assisted dying for minors in the Netherlands and Belgium, along with how each jurisdiction arrived at their respective policies and why the trajectory differed in Canada. After screening and compiling peer-reviewed and grey literature, we used Yanow's interpretive method for comparative work to review included materials. We framed findings using Hajer's discourse coalition theory. The Dutch and Belgian contexts relied upon a parliamentary approach in legalizing assisted dying for mature minors that emphasized suffering, whereas Canada's approach was initiated by a Supreme Court of Canada decision and emphasized human rights. While the Netherlands and Belgium viewed mature minors as capable to make decisions about assisted dying, the Canadian position on mature minors' decisional capacity with respect to assisted dying remains unsettled. This work contributes to understanding how context and sociopolitical values shape assisted dying legislations and treatment of mature minors, while highlighting areas requiring further study amid ongoing debate in Canada.
医疗辅助死亡（MAID）于 2016 年在加拿大合法化，适用于符合资格标准的 18 岁及以上的个人。目前，18 岁以下的个人在荷兰和比利时合法地可以获得辅助死亡，但在加拿大不行。迄今为止，尚无任何工作比较过这三个国家的政策制定过程和结果的因素。因此，我们的目的是探讨荷兰和比利时未成年辅助死亡的合法性，以及每个司法管辖区如何制定各自的政策，以及为什么加拿大的轨迹不同。在筛选和汇编同行评议和灰色文献后，我们使用 Yanow 的解释性比较工作方法来审查包括的材料。我们使用 Hajer 的话语联盟理论来构建研究结果。荷兰和比利时的背景依赖于议会的方法来使成熟未成年人的辅助死亡合法化，强调痛苦，而加拿大的方法是由加拿大最高法院的裁决发起的，强调人权。虽然荷兰和比利时认为成熟的未成年人有能力就辅助死亡做出决定，但加拿大对成熟未成年人在辅助死亡方面的决策能力的立场仍未确定。这项工作有助于了解背景和社会政治价值观如何塑造辅助死亡立法和对成熟未成年人的治疗，同时强调了在加拿大正在进行的辩论中需要进一步研究的领域。
